COI Rankings

V. Key Health Policy Issues >> A. Burden of Illness >>Cost-of-Illness (COI)>>COI Rankings (last updated 8.17.16)

Key Questions

What are the most expensive major diagnostic categories?

Total Costs (direct and indirect)

All the studies shown use a standardized methodology for measuring direct and indirect costs, so comparisons across major diagnostic categories are not as problematic as comparisons across specific conditions.

• Dorothy P. Rice. 1966. Estimating the Cost of Illness: Health Economics Series No. 6. PHS Pub. No. 947-6 (Washington, D.C.: U.S. Government Printing Office). Direct, morbidity and mortality losses for 1963 are reported for 8 major diagnostic categories: neoplasms; mental, psychoneurotic, and personality disorders; diseases of nervous system and sense organs; diseases of circulatory system; diseases of respiratory system; diseases of digestive system; diseases of bones and organs of movement; injuries; and all other.
• Dorothy P. Rice. Estimating the Cost of Illness. American Journal of Public Health 57(3) (March 1967): 424-440. The identical MDCs are reported from Rice’s PHS monograph, except that the estimates  do not account for the lifetime mortality losses of decedents in 1963, focusing instead on the mortality losses experienced during calendar year 1963.
• Dorothy P. Rice and Barbara S. Cooper. The Economic Cost of Illness Revisited. Social Security Bulletin 39(2) (Feb. 1976), 21-36. [Abstract][Full Text]. Direct, morbidity and mortality losses for 1972 are reported for 16 major diagnostic categories.
• Dorothy Rice, Thomas A. Hodgson and Andrea Kopstein. The Economic Costs of Illness: A Replication and Update. Health Care Financing Review 7, No. 1 (Fall 1985): 61-80. [Abstract] Direct, morbidity and mortality losses for 1980 are reported for 16 major diagnostic categories.

Direct Costs Only

• Hodgson TA, Kopstein AN. Health care expenditures for major diseases in 1980. Health Care Financing Review 1984;5(4):1-12.
• T.A. Hodgson and A.J. Cohen. Medical expenditures for major diseases, 1995. Health Care Financing Review 1999;21(2):119-16. [Full Text (pdf)]

What are the most expensive illnesses in the U.S.?

In a report to Congress (2000), the NIH director noted the following important limitations of comparing COI estimates across illnesses:

• “Variability in methods and data. There is considerable variability in the methods and data used to generate COI estimates. As a result, cost estimates for different diseases, or even for the same disease, may not be comparable. For example, one analysis may include only treatment costs, while another may include estimates of the value of lost production due to morbidity and mortality. Many patients have more than one disease/condition simultaneously, such as heart disease and diabetes, or have other underlying risk factors such as smoking and alcohol abuse. In such cases, costs may be allocated on the basis of primary diagnosis only, or some share may be attributed to comorbidities or underlying, contributory conditions. Furthermore, there is an inherent imprecision in estimating accurately items such as the costs of physician visits, hospital stays, and the value of lost productivity due to death and disabilities.
• Burden of illness exceeds economic costs. Estimates of the economic costs of illness do not capture some important aspects of the burden of illness such as reduced functioning, pain and suffering, and deterioration in other dimensions of health-related quality of life including emotional and psychological impacts on families, friends, and co-workers.”

“However, COI estimates can provide order of magnitude indicators of the economic burden of particular diseases.”  With these caveats in mind, the following provide rough estimates of the relative COI across selected conditions: